Pharmacists and Their Role in Controlling the Opioid Epidemic

As a member of the healthcare team the pharmacist has an equally important job in deterring this opioid epidemic that is currently wreaking havoc across our country. Many physicians prescribe prescriptions painkillers for patients and they come to the pharmacy; but we are lacking a systematic control method to prevent abuse. For example, in our country it is estimated that 21-29% of people who are prescribed prescription opioids misuse them according to the National Institute of Drug Abuse. New federal policies and procedures are making the epidemic a well-known issue and the regulations they are presenting are attempting to reverse years of damage that has already been done.  

One pharmacy has chosen to take a stand which is causing increased awareness due to the limitations it is taking. CVS reported early last week that they will begin to limit opioid prescriptions to a 7-day timeframe with certain restrictions; they are incorporating all of this into a new policy. The policy itself will not take affect till February of 2018 but this is a major topic in the control of opioids. “With a presence in nearly 10,000 communities across the country, we see firsthand the impact of the alarming and rapidly growing epidemic of opioid addiction and misuse,” said Larry J. Merlo, president and CEO of CVS Health.

In addition to the new policy, they will also be increasing the number of drug disposal units in its Medication Disposal for Safer Communities Program. This will help patients who are trying to adhere to the new set guidelines and dispose of old or extra medications they may have on hand. In this effort, CVS is working to try and adhere thoroughly to the CDC opioid prescribing guidelines.  

      

Most Opioid abusers use opioid for illicit reasons. As a pharmacist or a student pharmacist working in the pharmacy there are some little things you can do to help prevent this pandemic. By identifying some of the Red Flags of opioid abuse;

  • If a patient comes in and request for a particular brand or specific color of opioid. This should give you a clue that this patient is selling his or her medication.
  • If they use slang terms (street name of the drug)
  • Insist on paying with cash instead of allowing his or her insurance to cover the cost of the drug.
  • If you have new patients form the same prescriber coming to your pharmacy to fill only opioid.
  • Lack of eye contact especially when it is a new patient filling at your pharmacy
  • If the patient is nervous, be sure to know if they are hiding something  
  • Insisting on getting a refill before the actual refill date.
  • Tampering with the prescription.

In conclusion further steps need to be taken in the battle against opioids and this is one major step in the right direction. Pharmacist should attempt to take further action because we are the final check in the process before the patient receives the prescription medication.

Resources:

http://www.deadiversion.usdoj.gov/mtgs/pharm_awareness/conf_2013/march_2013/carter.pdf

https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/MedicaidIntegrityProgram/downloads/drugdiversion.pdf

http://vtdigger.org/2014/02/11/special-report-state-spends-millions-addiction-fighting-drug-diverted-street-sale/

https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis

http://www.cnn.com/2017/09/22/health/cvs-prescription-restrictions-opioids-bn/index.html

 

 

The National Opioid Epidemic and Pharmacist’s Role in Drug Diversion

An epidemic is ravaging our country and the ways in which we, as pharmacists and healthcare providers, can aid in the fight that is the “Opioid Crisis” are numerous. Take our beloved state of West Virginia for instance, where there have been 33.5 drug overdose deaths per 100,000 residents from 2011-13 compared to 22 per 100,000 residents in the years preceding. (1) “Wyoming, McDowell, Boone and Mingo [counties] lead the nation in fatal overdoses caused by pain pills, according to the U.S. Centers for Disease Control and Prevention.” (2) Over the past 6 years drug wholesalers have shipped nearly 800 million oxycodone and hydrocodone tablets drawing the attention of both the DEA and the state government. One of the nation’s largest wholesalers, Cardinal, agreed to pay over $40 million in fines to settle allegations of failure to report suspicious purchasing patterns for opioids. (3) You may find yourself asking what can I, a pharmacist, do to help?

First and foremost, counseling our patients on their medications and informing them of the potential risk of abuse is a great first step. It is important to get to know our patients and their situation so we can make sure the medications are used responsibly. Remind patients that medication is not to be shared with friends or family under any circumstances without the consult and consent of their health care provider. Inquire of your patient(s) whether the medication is working to alleviate symptoms and offer additional ways to help manage pain such as exercise, meditation, or even yoga. If needed, refer them to additional resources such as their doctor or other healthcare providers.

Secondly, inform patients about overdose protocol and the availability of lifesaving drugs such as naloxone (Narcan). Police and paramedics, who are usually the first responders to overdose victims, are also carrying naloxone to help curb loss of life. Educate individuals on the proper use of naloxone to reverse an overdose whether it accidental or intentional and where to purchase an emergency dose. Naloxone is now available by physician protocol at your local pharmacies in many states, including WV. It is imperative to instruct those who purchase naloxone that after administering a dose they must go to the hospital immediately because the effects will wear off and the victim will require hospital attention.

DEA 360 Strategy Meeting in the UC Ballroom!

DEA 360 Strategy Meeting in the UC Ballroom!

Pharmacists also have a responsibility to be proactive in this “Opioid Crisis” and become advocates for change in our communities. Reaching out to our state Senate and House of Representatives to promote new legislation and initiatives to curb this wave of abuse is another great step. On Wednesday January 25th 2017, DEA representatives came to the University of Charleston to host a stakeholders strategy meeting that focused on providing support for West Virginia for heroin and opioid use, and violence in our community. US Attorney Caroline Mastro has approved $500,000 for the trial portion of a program to diversify ways to help out this crisis. The DEA speakers addressed the present dismissive attitudes surrounding the subject and called out to leaders to unite with the common goal of fighting addiction in this state.

These patients are not the enemy but a casualty to what has historically been labeled a victimless crime. So the next time someone comes in a day early to fill their script or the doctor ups their dose don’t just shove them out the door replying, “it is too soon to fill” or “we don’t have any in stock.” Have a conversation with the patient to make sure they are aware that help is out there if they are ready to start their journey to recovery. Those who are abusing pain medications may be doing so in order to mask the pain of another situation and your conversation may spark the road to recovery! Please join us in the fight against the opioid epidemic.

References:

  1. http://www.dailymail.co.uk/news/article-3128229/West-Virginia-rate-drug-overdose-deaths.html
  2. http://www.foxbusiness.com/markets/2016/12/19/report-dea-records-show-west-virginia-flooded-with-drugs.html
  3. https://www.washingtonpost.com/national/health-science/cardinal-health-fined-44-million-for-opioid-reporting-violations/2017/01/11/4f217c44-d82c-11e6-9a36-1d296534b31e_story.html?utm_term=.d248d375b1fa

 

Reflections on President Obama’s Substance Abuse Forum: A Perspective From Two Student Pharmacists

Contributed by: Jeremy Arthur (Class of 2017) and Randal Steele (Class of 2016)

To view a video interview published by WOWKTV, please click here.

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Randal Steele (Class of 2016), Jeremy Arthur (Class of 2017), and Dean Easton at the Substance Abuse Forum

The Community Forum with President Barack Obama held on Wednesday, October 21, 2015 at Charleston’s East End Resource Center was an incredible, once in a lifetime experience for us. We believe the discussion will provide impetus for further action towards addressing the prescription opiate and heroin abuse epidemic occurring not only in West Virginia but throughout the United States. Sadly, as reported by the Charleston Gazette-Mail (10/17/15), West Virginia leads the nation in overdose deaths. In the U.S., overdose deaths involving prescription pain relievers rose more than 300 percent from 1999 through 2011, leading the Centers for Disease Control and Prevention (CDC) to declare these deaths an epidemic. Deaths associated with heroin overdose have also increased significantly over the last three years.

While the discussion took place in WV, the forum presented a bipartisan recognition that this epidemic does not discriminate—both rural and urban communities deal with prescription drug and heroin abuse—no one is exempt. Specifically, President Obama indicated that substance abuse is not isolated to one community—it can impact anyone regardless of their socioeconomic background. The focus of the discussion was the President’s plan for prevention and recovery.

The President’s 2016 budget proposed critical investments to intensify efforts to reduce opioid misuse and abuse, including $133 million in new funding to support prevention and education activities. It also focuses on helping individuals sustain their recovery from opioid use disorders. For example, Medication-Assisted Treatment (MAT) is an important tool for the treatment of opioid use disorders, but is too often out of reach for vulnerable populations.  The President’s plan is to make these programs more accessible to those in recovery and those seeking recovery and treatment.

One facet of drug abuse discussed during Wednesday’s forum was the impact of the epidemic on America’s youth. The increase of prescription medication abuse in children and adolescents is likely due to the misconception that prescription medications are safer than illegal substances and therefore, less likely to cause abusive behaviors. Many individuals view prescription medications as “safer” simply because they are prescribed by healthcare professionals. Providing education to today’s youth is imperative in curbing the progression of the prescription medication abuse epidemic. Educating children from a very young age about the danger of prescription medication and illegal drug use is a key prevention strategy according to the President. He explained that children are “sponges” for knowledge.

Pharmacists can and should help with prevention and treatment strategies in a number of ways including education at the pharmacy counter. In fact, prevention through education is an area where student pharmacists and pharmacists can have a large impact. By promoting safe and effective medication use to children, we can dispel any myths that encourage experimentation that may lead to abuse in children and adolescents. Education specifically aimed at parents and adults should center on secure medication storage and proper disposal. Keeping medications out of the hands of children or adults who intend to misuse them is key in preventing diversion. Pharmacists and student pharmacists can aid in proper medication disposal by partnering with local law enforcement and other agencies that specialize in medication removal to ensure that unused/unwanted medications do not contribute to someone’s addiction.

While the pharmacist’s role in preventing this epidemic and assisting with patient recovery wasn’t acknowledged specifically at the community event, we know pharmacists are integral to discussion, education, prevention, treatment, and recovery. As we gain recognition as valued members of the healthcare team, our role will become more apparent, whether we are educating patients, coordinating care with physicians, or facilitating the sale of naloxone to help with opiate overdoses. With the awareness raised by the event, along with pharmacist’s expanding role, we hope to see rates of recovery finally outgrowing rates of substance abuse deaths and in turn, see healthier communities—both rural and urban.